Provider Demographics
NPI:1851798136
Name:RICHARD M STOBER MD, PLC
Entity Type:Organization
Organization Name:RICHARD M STOBER MD, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:GAYE
Authorized Official - Last Name:HARTUNG
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:313-498-2470
Mailing Address - Street 1:30055 NORTHWESTERN HWY
Mailing Address - Street 2:STE. 150
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-3230
Mailing Address - Country:US
Mailing Address - Phone:248-865-4150
Mailing Address - Fax:
Practice Address - Street 1:30055 NORTHWESTERN HWY
Practice Address - Street 2:STE. 150
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-3230
Practice Address - Country:US
Practice Address - Phone:248-865-4150
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-02
Last Update Date:2014-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301045010207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIB45602Medicare UPIN